ABSTRACT The committee on IgA nephropathy of the Special Study Group on Progressive Glomerular Disease, Ministry of Health, Labor and Welfare of Japan published new clinical guidelines for the diagnosis and treatment of patients with IgA mephropathy in Japan. Patients with IgA nephropathy are divided into the following four groups at the time of renal biopsy: (a) Good prognosis group: almost no possibility of dialysis; (b) Relatively good prognosis group: possibility of dialysis is relatively low; (c) Relatively poor prognosis group: dialysis is likely to be required within 5-20 years; and (d) Poof prognosis group: the possibility of dialysis within 5 years is high. Based on these clinical guidelines, the committee on IgA nephropathy of the Special Study Group on Progressive Glomerular Disease, Ministry of Health, Labor and Welfare performed a multicenter trial on adrenocorticosteroids (PSL). IgA nephropathy patients were divided into two groups: PSL plus dilazep hydrochloride (anti-platelet drug) (PSL) group (33 patients) and dilazep hydrochloride alone (36 patients) and dilazep group. All these patients showed creatinine clearance (CCr) levels of more than 70 ml/min. The mean level of urinary protein excretion after one or three years of treatment (0.92 ± 1.21 g/day, 0.82 ± 1.03 g/day) was significantly lower than that before the start of treatment (1.39 ± 0.81 g/day) (p<0.05) in the PSL group. There were no significant differences in the mean level of CCr before and after one to four years of treatment in the PSL group. It appears that combination therapy with adrenocorticosteroids and dilazep hydrochloride was effective for patients in the mild stage (relatively good prognosis and relatively poor prognosis groups) of IgA nephropathy.
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